Do Former Smokers Exhibit a Distinct Profile Before and After Lumbar Spine Surgery?

Spine Jun 2017 Jazini E et al



Of 1187 eligible cases, 843 (71%) had complete data, with 477 Never, 250 Former, and 116 Current smokers. Among patients who had a fusion, baseline and 12-month post-op PROs were significantly different between cohorts, with Former smokers having intermediate scores between Current and Never smokers. In the decompression only group, 12-month ODI was worse in the Current smokers, but overall the effects were much less pronounced. There was a significant negative correlation between smoke-free days prior to surgery and baseline back pain, ODI, 12-month leg pain and ODI and improvement in ODI. However, the correlation coefficients were small.


Former smokers have distinct baseline and 12-month post-op PROs that are intermediate between those of never smokers and current smokers. Smoking cessation does not entirely mitigate the negative effects of smoking on baseline and postoperative PROs for patients undergoing lumbar fusion surgery. This effect is less pronounced in patients undergoing decompression alone.

Why Lumbar Artificial Disk Replacements (LADRs) Fail.

Clin surg 2017 Pettie et al



Every patient undergoing ADR at 1 IDE site by 2 surgeons was evaluated for clinical success. Failure was defined as <50% improvement in ODI and VAS or any additional surgery at index or adjacent spine motion segment. Three ADRs were evaluated: Maverick, 25 patients; Charité, 31 patients; and Kineflex, 35 patients. All procedures were 1-level operations performed at L4-L5 or L5-S1. Demographics and inclusion/exclusion criteria were similar and will be discussed.


Overall clinical failure occurred in 26% (24 of 91 patients) at 2-year follow-up. Clinical failure occurred in: 28% (Maverick) (7 of 25 patients), 39% (Charité) (12 of 31 patients), and 14% (Kineflex) (5 of 35 patients). Causes of failure included facet pathology, 50% of failure patients (12 of 24). Implant complications occurred in 5% of total patients and 21% of failure patients (5 of 24). Only 5 patients went from a success to failure after 3 months. Only 1 patient went from a failure to success after a facet rhizotomy 1 year after ADR.


Seventy-four percent of patients after ADR met strict clinical success after 2-year follow-up. The clinical success versus failure rate did not change from their 3-month follow-up in 85 of the 91 patients (93%). Overall clinical success may be improved most by patient selection and implant type.

Do manual therapies help low back pain? A comparative effectiveness meta-analysis.

Spine April 2014. Menke M.


Meta-analysis methodology was extended to derive comparative effectiveness information on spinal manipulation for low back pain.


Of 84% acute pain variance, 81% was from nonspecific factors and 3% from treatment. No treatment for acute pain exceeded sham’s effectiveness. Most acute results were within 95% confidence that predicted by natural history alone. For chronic pain, 66% of 98% was nonspecific, but treatments influenced 32% of outcomes. Chronic pain treatments also fit within 95% confidence bands as predicted by natural history. Though the evidential support for treating chronic back pain as compared with sham groups was weak, chronic pain seemed to respond to SMT, whereas whole systems of clinical management did not.


Meta-analyses can extract comparative effectiveness information from existing literature. The relatively small portion of outcomes attributable to treatment explains why past research results fail to converge on stable estimates. The probability of treatment superiority matched a binomial random process. Treatments serve to motivate, reassure, and calibrate patient expectations-features that might reduce medicalization and augment self-care. Exercise with authoritative support is an effective strategy for acute and chronic low back pain.

Intermittent cervical traction for neck pain: meta-analysis of recent RCTs.

Yang et al. Spine; July 2017.


These RCTs suggest significantly lower post-traction pain scores vs. patients getting placebo interventions. Short-term benefits are noted however significant differences on longer term follow up did not differ dramatically. It is noted further, less biased studies are necessary to draw firm conclusions of long-term benefits.

It’s important to note that ‘encouragement, ergonomic & postural advice and sensible exercise/fitness suggestions’ are all part of an evidenced-based treatment protocol.

Passive modalities and treatments are meant to stimulate healing and reduce pain-expression and the ensuing discouragement, it is vital to have non-traumatic interventions that can give good short-term relief.

Temporary, short-term relief may be all some conditions will manifest early on….that traction/decompression can improve pain quickly goes a long way to encourage and improve patient compliance so fitness and ergonomic consideration can be added in and compliance improved.


Decompression Versus Decompression and Fusion for Degenerative Lumbar Stenosis in a Workers’ Compensation Setting

Tye, Erik Y. BA*,†; Anderson, Joshua MD‡ et al Spine July 2017


Objective. The aim of this study was to compare outcomes in Workers’ compensation (WC) subjects receiving decompression alone versus decompression and fusion for the indication of degenerative spinal stenosis (DLS) without deformity or instability.

Summary of Background Data. The use of a fusion procedure during lumbar decompression for DLS alone remains controversial. We hypothesize that WC subjects receiving fusion and decompression will return to work less and incur greater medical costs than subjects receiving decompression alone.

Methods. Three hundred sixty-four Ohio WC subjects were identified  subjects who received an adjunctive fusion cost of the Ohio BWC on average, $46,115 more in costs accrued over 3 years after their index surgery compared with subjects who received a decompression alone.

Conclusion. Overall, fusion with decompression had a significantly negative impact on clinical outcomes in WC subjects with DLS. These results demonstrate the high risk of postoperative morbidity associated with fusion procedures and underscore the need to strongly reevaluate the use of fusion for DLS without instability in the WC population.


Evidence for a role of nerve injury in painful intervertebral disc degeneration: A cross-sectional proteomic analysis of human cerebrospinal fluid.

Kim TKY et al Spine 2017


Intervertebral disc degeneration (DD) is a cause of low back pain (LBP) in some individuals. However, while >30% of adults have DD, LBP only develops in a subset of individuals. To gain insight into the mechanisms underlying non-painful versus painful DD, human cerebrospinal fluid (CSF) protein expression was examined.


Cerebrospinal fluid was examined for differential protein expression in healthy controls, pain-free adults with asymptomatic intervertebral disc degeneration, and low back pain patients with painful intervertebral disc degeneration. While disc degeneration was related to inflammation regardless of pain status, painful degeneration was associated with markers linked to nerve injury.